Pharmacotherapy of dysthymia : a review

The clinical significance of chronic mild depression (dysthymia) is well recognized, but has not been the focus of extensive research. In particular, basic research on the phenomenology and treatment of these conditions is limited. Clinical lore suggests that psychotherapy, rather than pharmacotherapy, is the treatment of choice. This is based more on a theoretical understanding of chronic depression as a personality disorder rather than on actual treatment studies. This paper reviews the literature on the pharmacotherapy of dysthymia. The results provide substantial evidence for the efficacy of antidepressants in dysthymia, although the treatment response is less than that typically found in major depression. Furthermore, the findings suggest the possibility that monoamine oxidase inhibitors (MAOIs) may be superior to tricyclic antidepressants (TCAs) in the treatment of dysthymia, although this needs to be more rigorously evaluated. Some of the methodological problems with these studies are discussed. Additional areas of research, including the clinical and biological indicators of drug response, the use of non-TCA, nonMAOI drugs, the effects of pharmacological intervention on the development and maintenance of chronicity, and the comparison of and interaction between pharmacotherapy and psychotherapy are identified and suggested for future study.